Ⅲa期非小细胞肺癌术后辅助放射治疗疗效分析

目的：探讨Ⅲa期非小细胞肺癌（NSCLC）术后预防性照射的临床意义。方法：回顾性分析250例Ⅲa期NSCLC患者术后放射治疗与未放射治疗的生存率及复发情况。其中术后放射治疗115例,未放射治疗135例。肺鳞癌136例,放射治疗70例,未放射治疗66例,肺腺癌75例,肺鳞腺癌及其它类型39例,结果：术后放射治疗5年生存率为24．3％,未予放射治疗5年生态率为14．2％,两组比较有显著差别（P＜0．05）,肺鳞癌术后放射治疗5年生存率（26．7％）明显高于未放射治疗者（14．6％）（P＜0．05）,结论：能手术切除的Ⅲa期非小细胞肺癌术后应给预防性照射,以期提高生存期。     

扁桃体鳞状细胞癌的治疗

目的 分析扁桃体鳞状细胞癌不同治疗方案对患者生存率的影响,以期明确影响预后的因素并指导临床治疗.方法 回顾性分析1990～2011年南京医科大学附属淮安第一医院耳鼻咽喉头颈外科和头颈放疗科治疗的经病理证实、无远处转移的扁桃体鳞癌40例患者临床资料.采用Kaplan-Meier法和Log-rank检验进行生存分析,多因素分析采用Cox回归模型.结果 40例扁桃体鳞癌患者5年生存率为41.7％,Ⅰ～Ⅱ期5年生存率为74.2％,Ⅲ期为26.1％,Ⅳ期为0％,差异有统计学意义(x2=4.258,P＜0.05).单纯放疗组、综合治疗组(手术联合放化疗组和化疗联合放疗组)5年生存率分别为32.4％和30.2％,差异无统计学意义(x2=0.409,P＞0.05).有、无淋巴转移患者5年生存率分别为62.2％和8.4％,差异有统计学意义(x2 =9.987,P＜0.05).Cox多因素分析显示TNM分期、病理分化和颈淋巴结是否转移为影响预后的独立危险因素(P＜0.05).结论 Ⅰ～Ⅱ期扁桃体鳞癌的治疗倾向于单纯放疗,Ⅲ～Ⅳ期扁桃体鳞癌的治疗模式和疗效仍需进一步研究.TNM分期、病理分化和淋巴结是否转移为影响预后的独立危险因素.     

Ⅲ期食管癌综合治疗69例分析

将已确诊Ⅲ期食管癌鳞癌患者患者69例随机分为综合治疗组和单纯手术组。综合治疗组35例采用术前放疗化疗＋手术治疗＋术后化疗。单纯手术组34例采用食管癌根治术＋淋巴结三野清扫术。发现综合治疗组根治性手术切除率、1a生存率、无病生存率高于单纯手术组（P〈0．05）,单纯手术组开胸探查率高于综合治疗组（P〈0．05）。认为Ⅲ期食管癌综合治疗可以提高根治性手术切除率,改善近期预后及无病生存率,术后化疗对于预防肿瘤复发有一定作用。     

三种方法治疗原发性肝癌的疗效比较

148例肝癌患者随机分为三组。A组50例，单纯手术治疗；B组55例，行手术联合化疗泵化疗或术后肝动脉介入化疗（TACE）；C组43例，行手术联合复发灶内无水酒精注射（PEI）或射频消融（RFA）治疗。A、B、C三组1a生存率分别为62．52％、82．64％、81．09％，2a生存率分别为46．55％、73．82％、71．02％，B、C两组的1、2a生存率明显高于A组（P均〈0．05）。A、B组术后1a复发率分别为了49．36％、27．27％，2a复发率分别为68．62％、43．64％，B组1、2a复发率均低于A组（P均〈0．05）。认为以手术为主的综合疗法是原发性肝癌的首选治疗方法。     

Ⅲ期肺癌不同治疗模式的探讨

目的探讨Ⅲ期肺癌在不同治疗模式下的远期疗效,以提高患者生存率,改善预后。方法回顾性分析北京市结核病胸部肿瘤研究所自1995-2004年10年间1921例不同病理类型的Ⅲ期肺癌患者在不同治疗模式下的远期疗效并进行比较分析。结果在不同治疗模式下,以手术为主（辅以化、放疗）的综合治疗组606例、单纯手术组317例和非手术组998例,其1、3、5年生存率比较分别为66．0％、62．7％、51．2％;32．3％、21．4％、8-2％和19．3％、13．2％、4．2％。以手术为主的综合治疗组1、3、5年生存率高于单纯手术组和非手术组,其中综合治疗组和单纯手术组与非手术组比较1、3、5年生存率差异均有统计学意义（均P〈0．01）。结论根治性肿瘤切除,同时辅以化、放疗的综合治疗是Ⅲ期肺癌有效的冶疗模式。     

术前化疗对小细胞肺癌远期生存的影响

目的观察术前化疗联合外科手术治疗对小细胞肺癌（SCLC）长期生存的影响。方法总结北京市结核病胸部肿瘤研究所1994年1月至2005年1月手术切除的263例SCLC的综合治疗效果。比较术前化疗组（A组,n=111例）和术后化疗组（B组,n=96例）的治疗效果。结果全组5年生存率42．16％。A组5年生存率38．25％,B组5年生存4657％。A组5年生存率I期60．15％、Ⅱ期35．70％、Ⅲ。期40．16％、Ⅲb期14．29％、Ⅳ期0,A组5年生存率NO-1和N2为4012％和39．22％。B组5年生存率Ⅰ期61．10％、Ⅱ期50．23％、Ⅲa期42．32％、Ⅲb期2647％、Ⅳ期0,B组5年生存率NO-1和N2组为51．91％和42．69％。结论术前化疗病例比术后化疗病例有预后变差倾向;SCLC要取得较好的治疗效果,手术＋术后化疗模式不可缺少。     

食管癌根治术后及术后辅助放疗192例分析

目的 探讨食管癌根治术后辅助放疗以及影响预后的因素。方法 行根治术食管癌192例(病理分期为Ⅰ期6例，Ⅱa期104例，Ⅱb期46例，Ⅲ期36例)，其中44例合并术后辅助性放射治疗。结果 192例食管癌根治术后患者5年总的生存率为29．5％．1、3、5年总的生存率单手术组(72％、39．5％、29．1％)与术后放疗组(77．4％、40．8％、29．5％)统计学无明显差异（P=0．993)。Ⅰ Ⅱa期l、3和5年总生存率分别为82．5％、50．8％和41．0％，Ⅱb期分别为63．5％、26．8％和13．4％，Ⅲ期为56％、19．6％和9．8％，有统计学意义(P=0．0002)。胸上段食管癌l、3、5年生存率分别为100％、67．4％和44．9％，胸中段分别为72．5％、37．0％和29．2％。胸下段分别为70．0％、40．2％和27．8％，统计学无差异(P=0.51)。结论 食管癌根治术后辅助放疗对生存率的作用不太明显，应慎重实施；分期是影响食管癌预后的主要因素。     

术前新辅助化疗对小细胞肺癌远期生存的影响

目的揭示术前新辅助化疗对小细胞肺癌（SCLC）长期生存的影响对外科临床十分重要。方法总结1994年1月。2005年1月手术切除263例SCLC的综合治疗效果。分析比较术前新辅助化疗组（A组，n=111例）和术后化疗组（B组，n=96例）的治疗效果。结果A组5年生存率38．25％，B组5年生存46．57％。A组5年生存率Ⅰ期60．15％、Ⅱ期35．70％、Ⅲa期40．16％、Ⅲb期14．29％、Ⅳ期0，5年生存率N0-1和N2组为40，12％和39．22％。B组5年生存率Ⅰ期61．10％、Ⅱ期50．23％、Ⅲa期42．32％、Ⅲb期26．47％、1V期0，5年生存率N0-1和N2组为51．91％和42．69％。结论新辅助化疗病例与术后化疗病例相比预后差：SCLC要取得较好的治疗效果，术后化疗模式不可缺少。     

Ⅲa期非小细胞肺癌综合治疗的远期效果

对胸外科１９７９至１９９１年底手术切除的７８８例Ⅲａ期非小细胞肺癌（ＮＳＣＬＣ）的治疗结果进行分析。同时，将全组中３１６例综合治疗与４７２例单纯手术病例作对经丛组５年生存率１５．３％，综合治疗组５年生存率２３．０％，单纯手术组５年生存率１０．０％。综合治疗组５年生存率：鳞癌２６．６％，腺癌２２．８％。单纯术手术组５年自下而上率：鳞癌１４．１％，腺癌９．９％。本文分析表明：Ⅲａ期ＮＳＣＬＣ综合治疗住     

165例Ⅲ期小细胞肺癌的外科治疗评价

对胸外科１９７９年～１９９１年底经手术切除的１６５例Ⅲ期小细胞肺癌（ＳＣＩＣ）的治疗效果进行分析，并将其中的８７例综合治疗病例与７８例单纯手术病例进行对比讨论。同时，就综合治疗组中术前化学治疗（化疗）和（或）放射治疗（放疗）对预后的影响做了观察。全组５年生存率占１６．６％。ＴＮＭ分期５年生存率Ⅲａ期达２０．４％，Ⅲｂ期为０。综合治疗５年生存率占２２．８％，单纯手术５年生存率占７．９％。结果显示：Ⅲａ期ＳＣＬＣ综合治疗优于单纯手术治疗；综合治疗组中Ｎ＿２术前化疗和（或）放疗病例较术后化疗和（或）放疗病例预后变差；手术适应证应限于Ⅲａ期病例。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.